A 40-year-old male patient with a history of alcoholism is admitted for severe dehydration. Which electrolyte imbalance is most likely seen in this patient?

Appeared in: NORCET 5 mains

Explanation

Hypomagnesemia (a serum magnesium level below 1.3 mg/dL) is the most common electrolyte abnormality found in patients with chronic alcoholism.
This is caused by a combination of factors including poor dietary intake, malabsorption from the GI tract due to vomiting and diarrhea, and increased excretion of magnesium by the kidneys, which is a direct effect of alcohol.
The patient's presentation with severe dehydration can further complicate the clinical picture, but the underlying and most probable imbalance related to alcoholism is hypomagnesemia.
According to Brunner & Suddarth's Textbook of Medical-Surgical Nursing, chronic alcohol abuse is a major cause of symptomatic hypomagnesemia.

Option A: Hyperkalemia (high potassium) is not typical in this scenario. Chronic alcoholism usually leads to potassium depletion through poor intake, vomiting, diarrhea, and increased renal loss, often resulting in hypokalemia (low potassium).
Option B: Hypercalcemia (high calcium) is not associated with alcoholism. In fact, hypocalcemia (low calcium) is more common, often occurring as a secondary consequence of hypomagnesemia, because magnesium is essential for the proper secretion and function of parathyroid hormone (PTH), which regulates calcium.
Option D: Hyperphosphatemia (high phosphate) is incorrect. Similar to other electrolytes, chronic alcoholism is a classic cause of hypophosphatemia (low phosphate) due to malnutrition, malabsorption, and intracellular shifts of phosphate during alcohol withdrawal.

Clinical Relevance

Nursing practice connection: Use the key finding related to Electrolyte Imbalances in Alcohol Use Disorder to guide bedside assessment, documentation, and the next nursing action.
Nurses must maintain a high index of suspicion for hypomagnesemia in any patient with a history of chronic alcohol use, especially if they are admitted for illness, dehydration, or withdrawal.
Key nursing assessments include monitoring for neuromuscular irritability (tremors, muscle cramps, tetany, seizures), cardiac arrhythmias (especially torsades de pointes), and changes in mental status.
It is crucial to remember that other electrolytes, particularly potassium and calcium, are difficult to correct until the magnesium level is normalized. Therefore, magnesium should be replaced first or concurrently.

How to Approach the Question

First, identify the key patient population from the stem: a patient with a 'history of alcoholism'.
Next, note the presenting problem: 'severe dehydration'.
Recall the common pathophysiological effects of chronic alcohol use. Alcoholism leads to widespread nutritional deficiencies and electrolyte wasting.
Think about the prefixes 'hypo-' (low) and 'hyper-' (high). Chronic wasting conditions like alcoholism typically cause 'hypo-' states for most electrolytes.
Evaluate the options. Hyperkalemia, hypercalcemia, and hyperphosphatemia are all 'hyper-' states. Hypomagnesemia is a 'hypo-' state.
Based on this, and recalling that hypomagnesemia is a classic, hallmark finding in alcoholism, you can identify it as the most likely answer.

Concept Tested & Keywords

Concept Tested: Electrolyte Imbalances in Alcohol Use Disorder
Stem keywords: alcoholism, severe dehydration, electrolyte imbalance
Lead-in keywords: most likely
Clinical cues: History of alcoholism is a major risk factor for nutritional and electrolyte deficiencies.
Clinical cues: Severe dehydration can exacerbate underlying electrolyte problems.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 157-159

E6 Nursing Fundamentals Taylor p. 779-781

Practise the full NORCET 5 mains

Attempt every question from this paper in a timed mock, then review the full solution for each one.